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General NPI Number Information
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NPI Number | 1588681142
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Entity Type | Organization
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Legal Business Name | DIANE L PAYNE PHD PA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 3111 SPRINGBANK LN SUITE I
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City | CHARLOTTE
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State | NC
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Zip | 28226-3372
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Country | US
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Telephone | 704-540-0625
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 SPRINGBANK LN SUITE I
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City | CHARLOTTE
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State | NC
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Zip | 28226-3372
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Country | US
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Telephone | 704-540-0625
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANE L PAYNE
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Credential |
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Telephone | 704-222-3429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1615
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License Number State | NC
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